Hearing Loss & Tinnitus

Loss of hearing

Note: the following information is sourced from the UK National Health Services Choices website

Hearing loss is the result of sound signals not reaching the brain. There are two main types of hearing loss, depending on where the problem lies:

sensorineural hearing loss – caused by damage to the sensitive hair cells inside the inner ear or damage to the auditory nerve; this occurs naturally with age or as a result of injury

conductive hearing loss – when sounds are unable to pass from your outer ear to your inner ear, often because of a blockage such as earwax, glue ear or a build-up of fluid from an ear infection, or because of a perforated ear drum or disorder of the hearing bones

It’s also possible to have both these types of hearing loss. This is known as mixed hearing loss.

Some people are born with hearing loss, but most cases develop as you get older.

Signs of Hearing Loss

Hearing loss is sometimes sudden, but often it’s gradual and you may not notice it at first. Being aware of the early signs can help you identify the problem quickly.

It’s important to spot hearing loss as soon as possible, because treatment is often more beneficial if started early.

General signs of hearing loss

Early signs of hearing loss can include:

difficulty hearing other people clearly and misunderstanding what they say, especially in group situations

asking people to repeat themselves

listening to music or watching television with the volume higher than other people need

difficulty hearing the telephone or doorbell

finding it difficult to tell which direction noise is coming from

regularly feeling tired or stressed, from having to concentrate while listening

In some cases, you may recognise signs of hearing loss in someone else before they notice it themselves. Research suggests it takes 10 years from the time someone notices they have hearing loss, before they do anything about it.

If you also hear a ringing, buzzing or whistling sound in your ears, this could be a sign of tinnitus, which is often associated with hearing loss.

Seeking medical help

Make an appointment to see your GP if you’re having problems with your hearing.

If you wake up with a sudden loss of hearing in one ear or lose the hearing in one ear within a couple of days, you should see your GP as soon as possible.

Causes of hearing loss

Age

Age is the biggest single cause of hearing loss. Hearing loss that develops as a result of getting older is often known as age-related hearing loss or presbycusis.

Most people begin to lose a small amount of their hearing from around 40 years of age. This hearing loss increases as you get older. By the age of 80, most people have significant hearing problems.

As your hearing starts to deteriorate, high-frequency sounds, such as female or children’s voices, may become difficult to hear. It may also be harder to hear consonants such as “s”, “f” and “th”. This can make understanding speech in background noise very difficult.

Loud noises

Another common cause of hearing loss is damage to the ear from repeated exposure to loud noises over time. This is known as noise-induced hearing loss, and it occurs when the sensitive hair cells inside the cochlea become damaged.

Other types of sensorineural hearing loss

Sensorineural hearing loss occurs if the sensitive hair cells inside the cochlea are damaged, or as a result of damage to the auditory nerve (which transmits sound to the brain). In some cases, both may be damaged.

Hearing loss caused by age and exposure to loud noises are both types of sensorineural hearing loss.

Sensorineural hearing loss can also be caused by:

the genes you inherit – some people may be born deaf or become deaf over time because of a genetic abnormality

viral infections of the inner ear – such as mumps or measles

viral infections of the auditory nerve – such as mumps or rubella

Ménière’s disease – where a person suffers with vertigo, spells of hearing loss, tinnitus and the feeling of a blockage in the ear

acoustic neuroma – a non-cancerous (benign) growth on or near the auditory nerve

meningitis – an infection of the protective membranes that surround the brain and spinal cord

stroke – where the blood supply to the brain is cut off or interrupted

Some treatments and medicines, such as radiotherapy for nasal and sinus cancer, certain chemotherapy medicines or certain antibiotics can also damage the cochlea and the auditory nerve, causing sensorineural hearing loss.

People with diabetes, chronic kidney disease and cardiovascular disease are also at increased risk of hearing loss.

Sensorineural hearing loss is permanent and hearing aids are often required to improve hearing in these cases. Read more about treating hearing loss.

Causes of conductive hearing loss

Conductive hearing loss is usually caused by a blockage, such as having too much ear wax, a build-up of fluid in the ear (glue ear), or an ear infection.

Conductive hearing loss can also be caused by:

a perforated eardrum – where the eardrum is torn or has a hole in it

otosclerosis – an abnormal growth of bone in the middle ear which causes the inner hearing bone (the stapes) to be less mobile and less effective at transmitting sound

damage to the hearing bones from injury, a collapsed ear drum or conditions such as cholesteatoma

swelling around the eustachian tube – caused by jaw surgery or radiotherapy for nasal and sinus cancer

malformation of the ear

Eustachian tube dysfunction

something becoming trapped in the ear (a foreign body)

Conductive hearing loss is usually temporary and can often be treated with medication or minor surgery. Read more about treating hearing loss.

Diagnosing Hearing Loss

See your GP if you’re having problems with your hearing. They’ll examine your ears and carry out some simple hearing tests.

Ear examination

During an ear examination, an instrument with a light at the end called an auriscope (or otoscope) is used to look for anything abnormal, including:

a blockage caused by earwax, fluid or an object

an ear canal infection

a bulging ear drum – indicating an infection inside the middle ear

fluid behind the ear drum – known as glue ear

a perforated ear drum

a collapsed ear drum

skin collected in the middle ear (cholesteatoma)

Your GP will ask if you have any pain in your ear and when you first noticed the hearing loss.

Referral to a specialist

Your GP may refer you to an ear, nose and throat (ENT) specialist or an audiologist (a hearing specialist). The specialist will carry out further hearing tests to help determine what’s causing your hearing loss and recommend the best course of treatment.

Some of the hearing tests you may have include a:

tuning fork test (sometimes performed by your GP)

pure tone audiometry

bone conduction test

Tuning fork test

A tuning fork is a Y-shaped, metallic object. It produces sound waves at a fixed pitch when it’s gently tapped and can be used to test different aspects of your hearing.

The tester taps the tuning fork on their elbow or knee to make it vibrate, before holding it at different places around your head.

This test can help determine if you have conductive hearing loss, which is hearing loss caused by sounds not being able to pass freely into the inner ear, or sensorineural hearing loss, where the inner ear or hearing nerve isn’t working properly.

Pure tone audiometry

Pure tone audiometry tests the hearing of both ears. During the test, a machine called an audiometer produces sounds at various volumes and frequencies (pitches). You listen to the sounds through headphones and respond when you hear them, usually by pressing a button.

Bone conduction test

A bone conduction test is often carried out as part of a routine pure tone audiometry test in adults. It’s used to check if you have sensorineural hearing loss, by testing how well your inner ear is working.

Bone conduction involves placing a vibrating probe against the mastoid bone behind the ear. It tests how well sounds transmitted through the bone are heard.

Bone conduction is a more sophisticated version of the tuning fork test, and when used together with pure tone audiometry, it can help to determine whether hearing loss comes from the outer and middle ear (conductive hearing loss), the inner ear (sensorineural hearing loss), or both.

Preventing/Treating hearing loss

It isn’t always possible to prevent hearing loss if you have an underlying condition that causes you to lose your hearing.

However, there are several things you can do to reduce the risk of hearing loss from long-term exposure to loud noise. This includes not having music or the television on at a loud volume at home and using ear protection at loud music events or in noisy work environments.

You should also see your GP if you have signs of an ear infection, such as flu-like symptoms, severe earache, discharge or hearing loss.

How hearing loss is treated depends on the underlying cause of the condition.

Hearing loss that occurs when sounds are unable to pass into the inner ear (conductive hearing loss) is often temporary and treatable.

For example, earwax build-up can be removed by drops, a syringe or suction. Hearing loss caused by a bacterial infection can be treated with antibiotics. Surgery can be used to drain a fluid build-up, repair a perforated eardrum, or correct problems with the hearing bones.

However, hearing loss caused by damage to the inner ear or to the nerves that transmit sound to brain (sensorineural hearing loss) is permanent.

If your hearing is impaired, treatment can improve your hearing and quality of life. Some of these treatments are discussed below.

Hearing aids

If you have hearing problems, you may be able to wear a hearing aid.

A hearing aid is an electronic device that consists of a microphone, an amplifier, a loudspeaker and a battery. It increases the volume of sound entering your ear, so you can hear things more clearly.

The microphone picks up sound, which is made louder by the amplifier. Hearing aids are fitted with devices that can distinguish between background noise, such as traffic, and foreground noise, such as conversation.

Modern hearing aids are very small and discreet, and can often be worn inside your ear.

Hearing aids help improve hearing, but don’t give you your hearing back. They’re suitable for most people, but may be less effective for people with profound hearing impairment or certain conditions. Your GP or audiologist (hearing specialist) can advise you about whether a hearing aid is suitable for you.

If a hearing aid is recommended, an audiologist may take an impression of your ear so the hearing aid fits you perfectly or may show you an open fit hearing aid. The hearing aid will be adjusted to suit your level of hearing impairment. You’ll also be shown how to use and care for it.

After your hearing aid has been fitted, you should have a follow-up appointment within 12 weeks.

If you experience problems using a hearing aid – such as distortion and repeated infections – that can’t be corrected by an audiologist, you may benefit from different treatments. An ear, nose and throat (ENT) surgeon can discuss these with you. An ENT surgeon with a special interest in ear surgery is called an otologist.

Tinnitus

Note: the following information is sourced from the Tinnitus Association of Victoria

Tinnitus is a common condition that refers to a range of sounds or ‘head noises’ such as ringing, hissing, buzzing or clicking. There is no cure for tinnitus, but with appropriate support the condition can be successfully managed so that it has little or no impact on a person’s life.

Mechanisms of Tinnitus

When the brain first hears tinnitus it attempts to classify the sound from its stored data of sounds with which it is familiar. When no ‘match’ can be made from previous experience, the brain focuses on the sound to such an extent that the sound is effectively magnified and the brain gives it a level of importance it does not deserve.

This happens in the same way as when you are alone in your house at night and you hear the sound of a blind knocking against a window sill, or the floor boards expanding or contracting. Your senses go into a state of high alert, and the sounds are given unnecessary significance. This is because the limbic system within the brain is interpreting the sounds as signals of possible danger.

In the same way, whenever you are aware of your tinnitus, your brain automatically interprets the sounds as a sign that something is terribly wrong, or as a danger signal. If this continues, your mind becomes obsessed with the sound, continually focusing on it and thus maintaining your body and mind in a state of high alert.

If this fearful pattern of thought is left unchecked, the negative response to the sound is reinforced. This ‘programming’ of the brain must be corrected so that you learn to manage your tinnitus rather than letting it manage you.

How Common is Tinnitus ?

Tinnitus is a symptom of a malfunction of the auditory system where by the sufferer hears sounds in the ears and head which are not associated with any external source.

Approximately 17-20% of the population suffer from tinnitus to varying degrees.

Tinnitus can be extremely debilitating, affecting peoples’ abilities to work or cope with normal life activities.

Many people are told that ‘there is nothing that can be done’ or ‘you will have to learn to live with it’. This is totally wrong. Although there is no cure, people with tinnitus can learn techniques to successfully manage their tinnitus to the point where the tinnitus is no longer a problem for them, and they can continue to lead full and productive lives.

Tinnitus Management

The aim of every tinnitus sufferer is to habituate to their tinnitus.

This means reaching a state of mind where you no longer have a negative emotional response to your tinnitus.

We habituate or adapt to various stimuli every day of our lives:

the feel of our clothes on our bodies

the unchanging things we see around us each day

traffic noise….

We all know people who have moved to a home or workplace on a busy street. At first they find the traffic noise distracting, even distressing, but in time reach the point where they are rarely even aware of the noise that surrounds them. This is called habituation.

In general, the noises we are most able to ignore are predictable, repetitive sounds we perceive as nonthreatening, uninteresting and unimportant.

Progression towards Habituation

Progression towards habituation is not a case of going from one level to another and not having relapses or bad days. Tinnitus sufferers have days when they may be overtired or have underlying stress in their lives. Tinnitus will be more troublesome on those days. However, through learning to manage your tinnitus, the bad days will be fewer and further apart.

As you learn to manage your tinnitus and progress towards habituation, changes will take place in the areas of stress and depression and anxiety, your ability to concentrate, shifting your focus from the tinnitus and insomnia. In the early stages the majority of people have trouble in several or all of these areas. As you move towards habituation, each area will gradually improve to the point where you are rarely troubled by your tinnitus and it does not interfere with normal activities. Although the tinnitus will still be present, you will not be emotionally disturbed by it, or overly aware of it.

The Tinnitus Association of Victoria have produced a DVD called “4 Keys to Successful Tinnitus Management”. You can purchase a copy from our shop.